Pandemic Proof: Preparing for What Comes Next

Javier Guzman: You are listening to Pandemic Proof from the Center for Global Development. In this podcast, we explore policies and reforms to better prepare and respond to infectious disease threats like COVID-19, but also other nasty viruses, microbes, and fungi that can throw our health, our communities, and our economies into crisis. Join us as we envision ways to better protect our world in the future. I'm your host, Javier Guzman. Let's get started.

Thank you very much for being with us in this second season of Pandemic Proof. We started Pandemic Proof in the later part of the COVID-19 pandemic, July 2022, and we started because we wanted to first, understand the risk of having another pandemic. And two, we wanted to reflect on the global system we had to face COVID-19. What had gone well? What needed to be improved? 

And it was a very interesting exercise because our guests were very clear that the risk is only getting higher, and this is not gonna be a once in a lifetime possibility. Some of our guests talked about having a 60% probability over a 25 year period, or a 50-50 chance, or a conflict that another pandemic on the scale of COVID-19 would occur in the next 25 years. We need to be better prepared. We need to have a proper system to prevent, detect, and respond to pandemic threats and to infectious disease outbreaks.

And when reflecting on the system we had, we went through a lot of the weaknesses that were evident during the response to the COVID-19 pandemic. From countries not being able and not being willing to respond, to the lack of regional and global response, to how to access medical countermeasures and the importance of developing and deploying medical countermeasures. And we heard very good, innovative ideas about how to improve the global system.

Now in the second season, we had five very good episodes. We were able to have conversations at the national level with the governments of the United States and Japan, at the regional level with the head of the Africa Centers for Disease Control, and at the global level with the World Health Organization, and also the person who's chairing the negotiations of the Pandemic Accord, Precious Matsoso.

In this final episode, I wanted to highlight a few key messages, something that has really made a big impression on me. And the big word is Progress. But the second big word is Change, and Challenge. And clearly what we saw is a lot of progress in terms of putting in place policies at the national, regional, and global level to be better prepared, from the US government deciding on having a clearer, more responsive architecture for pandemic preparedness and response, to the linkage with universal health coverage and setting up the UHC Hub in Japan, to the WHO trying to improve the way the organization is financed, moving to a replenishment model. So a lot of progress there.

A lot of our guests highlighted interesting milestones, like the creation of the Pandemic Fund within the World Bank, but also how responsive Africa CDC was when declaring for the first time a public health emergency of regional concern when they basically assessed the magnitude of the mpox outbreak. So there's been a lot of progress, but that progress also has a limit, and we've seen that limit, and we spoke to our guests about that limit. And we saw the limitation in terms of the success of the WHO financing model in relation to not being able to sign the Pandemic Accord and not agreeing on the importance of equity in the global response to pandemics. And that clearly has been difficult in terms of having a coordinated global mechanism or something that we can refer to and use when the time comes.

It's important to also see change and challenge going forward because when we started this second season, it feels like it was a different world. Of course, we were talking about lessons learned from the pandemic. We were talking about how to be better prepared. We were talking about plugging the gaps, but at the time, we didn't know about what the new US administration would do. We see how the decisions made by the Trump administration clearly have had an effect on the overall global health architecture and overall level of preparedness.

First of all, the administration decided to pull out from WHO, so the WHO financing model we were talking about last year is now no longer up to date in terms of being able to properly finance the organization. Now there's an additional financial gap. And two, clearly a Pandemic Accord will not be negotiated with the US and the question is whether it will be negotiated at all or it will be agreed at all.

So change has been a consistent factor in these past months. And looking at the future, it's clear that global health overall will need to think about a new chapter and pandemic preparedness will also need to be part of that conversation. And that new chapter has interesting but challenging elements.

The first one is we will have less money. We will have less money because of the aid cuts, but also because of the fiscal crisis we're in. And the aid cuts are coming not just from the US but also from the European governments. Clearly health is no longer the priority and pandemic preparedness is actually not as important as it was right after the COVID-19 pandemic. The priority seems to be now investment in defense and investment in other areas, so there will be a very difficult uphill challenge in trying to get enough funding, so we need to do more with less. So less money is one of the features.

The second feature is how governments in low and middle income countries are really at the center of the decision making and should be at the center of the decision making. And that really resonates with what Dr. Jean Kaseya was telling us in the first episode. It's important for governments in low and middle income countries, not only to be responsible for their populations, but also to have a say on the regional and global conversations and the regional and global discourse.

That is hard because those governments have not prioritized historically, in the past couple of decades, health expenditure. And that might be one of the unintended consequences of the golden era of global health, where we had a lot of aid and where we had a lot of grant financing and governments didn't feel the need to increase their domestic expenditure. So that responsibility comes with the need to increase investment.

But clearly low income countries do not have the possibility to increase that investment as much as they need. And then we get into the third point, which is the role of the global system. What is the role of the international community?

Because what we're talking about here is a global public good for us all to be safe, for us all to be secure, we need to clearly work together, and that goes beyond national responses. And here we have the question of how grant financing will be replaced, or how other types of financing could actually play a role in the future.

And we'll see how this evolves. What is the role of other types of financing, the role of concessional financing, of course the role of multilateral development banks, but the role of the private sector as well – clearly that's something that is still a question mark. The gaps that we see are massive and we'll see how the world responds to those.

So going forward, we will all need to be mindful of this new landscape, this new challenge, this new possibility, and this difficult time which we're in. But the global health architecture 2.0, global health financing 2.0, pandemic preparedness and response 2.0, will need to be part of the global conversation.

And we hope that we can engage those decision makers who are now busy trying to solve the immediate fires – because lack of financing, and the US pulling out from a lot of these countries, and the UK pulling out from a lot of these countries, and Europeans cutting aid, I mean, of course a lot of countries are basically putting out fires, trying to see how they could actually respond.

But it is an opportunity, a real opportunity to reimagine the system. An opportunity to really understand the value of health, understanding the value of preparedness, and understanding the value of appropriately having health systems that are able to not just function normally and respond to their citizens, but identify pandemic threats and act quickly upon them.

So we'll finish this podcast, this conversation, with this very big open question. Are we up to the challenge? Are all stakeholders up to the challenge? And we hope that the answer is yes, and we hope that the conversation will still be at the top of the global agenda and that we are up to the task.

That is down to governments in low and middle income countries, governments in high income countries, but also multilateral institutions, international financing institutions, civil society, and the public. The public will need to understand and demand a more prepared world, a world where we see pandemic preparedness and response as a key prerequisite for our survival.

So thank you all very much for joining. It's been a pleasure to have you here with us at Pandemic Proof. Please do continue to follow all the work that my colleagues at the Center for Global Development are producing, and we hope to see you again in the near future.

Thanks for listening to Pandemic Proof from the Center for Global Development. Very special thanks to the CGD podcast team, Sophia Greenhoe, Stephanie Donohoe, and Soundeazy, for making it happen. Pandemic Proof is available on the CGD Podcast stream so make sure you are subscribed to the CGD Podcast on Apple, Spotify, or wherever you listen to podcasts.

And remember, you can check out all of our work on pandemic preparedness and beyond at CGDev.org. That's CGDev.org. Thank you very much.